Widespread screening for prostate cancer has led to an increased incidence, an improved disease specific survival, but also to overdiagnosis and overtreatment. The limitations of screening tools, especially PSA, have led to active investigation of new biomarkers in recent years. Urinary markers, suitable for large scale use, minimally invasive collected, arouse of particular interest. Numerous protein, DNA or RNA markers are explored in order to improve detection and prognostic evaluation of prostate cancer. Some of them have already shown clinical values. PCA3 provided particularly encouraging results for the specific population of patients having a first set of negative biopsy, for which using PCA3 assay could allow to avoid unnecessary repeated biopsy. Fusion genes showed promising abilities in prostate cancer detection. New research methods are also emerging, and high-throughput technologies will facilitate high-dimensional biomarker discovery. Future approaches will probably integrate proteomic, transcriptomic and multiplex approaches to identify combinations of multiple biomarkers to optimize the detection of prostate cancer. In the near future, these markers would probably be able to provide prognostic data to discriminate significant cancers, a major challenge for prostate cancer treatment.

The Aurora kinase family plays a crucial role in the regulation of mitosis. Over-expression of Aurora A and B has been reported in many malignant tumors. The objective of this study was to analyze the expression of Aurora A and B in renal cell carcinoma (RCC) and its correlation with usual clinical and pathological parameters.

Methods

In a retrospective study, have been studied the tumoral samples of 40 consecutive patients who had been operated between 2003 and 2006 for a renal tumor. RNA was extracted from frozen corresponding tumoral samples. Thirty-one samples were retained based on RNA quality. RT-PCR was done on each of these samples to assess the expression of Aurora A and B genes. Statistical analysis was performed using Chi-square test to compare Aurora A and B levels.

Results

Median age was 65 years (35–82). Seven (22%) patients had nodal invasion and eight (26%) had distant metastases. Most of the tumors (74%) were grade 3 or 4. Eighteen patients (58%) had clear cell cancer histology, 12 (39%) had papillary histology, and one a Bellini type tumor. Aurora A overexpression was associated with lymph node invasion (p=0.001). Aurora B over-expression was associated with both nodal involvement (p=0.02) and histologic subtype (significantly over-expressed in clear cell tumors; p=0.001).

Conclusions

Aurora A and B were differentially over-expressed in clear cell RCC and primary tumors of patients with lymph node involvement.

The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries.

Material and methods

A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence.

Results

Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30–49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases.

Conclusion

Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

Retrospective evaluation of the efficacy and morbidity of simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL).

Methods

From January1993 to July2009, 60 patients have undergone SB-PCNL over a series of 1709 PCNL. Thirty men and 30 women, mean age 45years old (13–78), were treated for bilateral renal stones (120 kidneys) of 1177mm2 (268–4972mm2); 25 were complete staghorn stones.

Results

Operating time for the first side of PCNL was 80min (30–270) and 45min (10–90) for the opposite side. Overall OR occupation was 188min (90–360). Forty-five patients were stone free after one session; 15 patients (25%) have a complementary treatment to be stone free: five PCNL (one bilateral); eight ESWL (four with JJ stent) and two flexible ureteroscopy. No blood transfusion was required. Renal function was unchanged at 1 month. Clavien grade for complications were as follows: two grade IIIb, one grade IVa and one grade IVb. Hospitalization stay was 4±4.9days (2–35) taking account of two major sepsis (one pulmonary and one septicemia).

Conclusion

SB-PCNL was well tolerated with comparable morbidity and efficacy to PCNL performed on each side in two separate sessions. Nevertheless, SB-PCNL has to be performed for selected patients in expert centers.

Role of surgery (cytoreductive nephrectomy and metastasectomy) in the management of metastatic renal cell carcinoma: A literature review

2010

- Articles de revue

- Réf : Prog Urol, 2010, 13, 20, 1175-1183

Introduction

Cytoreductive nephrectomy is an established treatment option prior immunotherapy in well-selected patients with metastatic renal cell carcinoma. With the recent introduction of new targeted agents, the role of surgery has been source of controversy. This review examines the role of cytoreductive nephrectomy during the immunotherapy era, then in the new targeted therapies era. This review also summarizes the optimal timing of these treatments, the prognostic factors predicting outcome following cytoreductive nephrectomy, the role of metastasectomy, partial and laparoscopic cytoreductive nephrectomy.

Oncologic outcomes after radical prostatectomy: French validation of the D'Amico risk group classification

2010

- Articles originaux

- Réf : Prog Urol, 2010, 13, 20, 1206-1212

Introduction

Purpose

To validate the D’Amico risk group classification in French consecutive series and to analyse recurrence risk factor after radical prostatectomy (RP) for prostate cancer.

Material

We retrospectively analyzed data collected from 10/2000 to 05/2009 for 730 consecutive patients who underwent RP for clinically localized or locally advanced prostate cancer (cT1–cT3) in our institution. Biochemical recurrence (BCR) was defined by prostate-specific antigen (PSA) of greater than 0.1ng/ml, with rising PSA at two consecutive dosages. Postoperative survival was estimated using the Kaplan–Meier method after D’Amico’s group stratification. The accuracy of the model was evaluated using the Harrell’s concordance index. The impact on outcomes of preoperative PSA and pathological features was evaluated using a monovariate and multivariate Cox analysis.

We externally validated the ability of the D’Amico’s risk group stratification to predict disease progression following RP in European patients. Preoperative PSA, pathological stage, Gleason score and surgical margins status predicted BCR after RP in our series through a multivariate analysis.

Persistent Müllerian ducts syndrome is a rare form of internal male pseudohermaphroditism, characterized by the presence of the uterus, fallopian tubes and upper vagina in an otherwise normally virilised male with a 46 XY karyotype. It is the result of a deficiency in anti-Müllerian hormone or abnormality of this hormone receptor. Often, the diagnosis is made incidentally during surgical exploration for cryptorchidism or herniorrhaphy, and exceptionally during cancer of ectopic testis. We discuss a rare case of this syndrome revealed by a bilateral intra-abdominal gonadal tumor.

Renal hybrid tumors (HT) are characterized by the association of both oncocytes- and chromophobe-cells within the same tumor. They have been reported in patients with Birt-Hogg-Dube (BHD) syndrome. The aim of this report was to describe two cases of HT and summarize recent literature.

Patient and method

Case study was summarized from the patient’s medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database.

Results

Two patients were diagnosed with multiple but small tumors of the kidney, and were treated with partial nephrectomy. Pathological analysis of these tumors showed oncocytoma-like and chromophobe-like cells intermixed in the same stroma.

Conclusions

HT may constitute a spectrum of tumors between renal oncocytoma and chromophobe renal cell carcinoma. From a pragmatic management perspective, it would be appropriate to consider such tumors as chromophobe carcinoma. In case of HT, a genetic study for BHD syndrome can be proposed to family relatives.